Everyone Has a Voice

Lori Dewalt

Communication and coordination among all team members in high-risk domains are critical to successful human performance. The field of Crew Resource Management (CRM) was developed to provide a mechanism for improving communication and team situational awareness within aviation in the late 1970s and early 1980s. The basic building blocks of CRM include emphasizing teamwork and strategy, developing and understanding situational awareness, and improving interpersonal communication. Like aviation, the healthcare industry involves considerable coordination among many people, is constantly adapting to changing conditions, and has the potential for high consequences for communication errors.

Crew Resource Management Model

The complex tasks involved in most healthcare procedures can introduce communication risks, such as role confusion within the team, interruptions, noise, and handovers. CRM provides a defined framework for addressing the underlying causes of communication problems and managing the consequences of these problems. Healthcare CRM team training involves defining the team, understanding basic human factors, and applying the knowledge to case studies and eventually the workplace. CRM provides guidance to individuals, teams, and organizations.

Consistent Communication

Many hospitals have implemented checklists to guide team communication before, during, and after medical procedures. The checklist promotes team situation awareness to ensure all steps are completed before moving on. Both doctors, nurses, and other hospital staff are trained to use checklists to verify the patient’s information. Within each team, team leaders are assigned to brief the team and to introduce members to each other. The team leader will foster situational awareness while observing the team work. Team leaders watch and listen to other team members regardless of seniority or rank and verify that communication is clear and concise.

Everyone Has a Voice

A key benefit of CRM is that it provides a voice to all team members, even those who might not have been given a voice under traditional workplace hierarchies. Appropriate communication techniques are designed to allow any team member to question superiors without fear of retribution. Studies on CRM in healthcare have found associations between better nurse-physician communication, collaboration and more positive patient outcomes, i.e., lower mortality, higher satisfaction, and lower readmission rates.

Impact on Human Performance

Improving patient safety and promoting positive patient outcomes have always been the goal of the healthcare industry. Most CRM programs have focused on reducing communication mistakes to improve patient safety. Improvements have directly impacted many areas of patient safety including pre-op or anesthesia hand-off, communication to management, debrief and follow up. Specific efforts have involved the inclusion of pre-procedure briefings, soliciting feedback from all team members, improving management awareness, and eliminating the fear of retribution for voicing concerns. Additional individual job satisfaction benefits have also been reported by providing clearly defined roles to each team member and giving each team member a voice to impact patient safety. Nurses have been the strongestadvocates of CRM. Nurses report a higher level of respect from doctors after CRM. Job satisfaction is elevated as nurses believe their input is more valued by the doctor.

The Way Forward

Clear, consistent communication is a critical factor in ensuring successful human performance in high-consequence areas like health care. An effective Crew Resource Management program is an essential tool for the healthcare environment to increase patient safety, human performance, worker satisfaction, and overall communication.

Lori S. Dewalt is a Senior Human Factors Engineer on the operational human performance assessment team at Fort Hill Group. She has previously worked to assess human performance in the nuclear and commercial aviation domains. Connect with Lori on Linkedin